190 THE SEX-COMPLEX 



exophthalmic goitre is not constant ; sometimes the 

 goitre diminishes in size, and sometimes it is increased 

 during the period ". 

 Hyper- The relation of excessive thyroid secretion to preg- 



and'preg- 111 nancy is very interesting, but very little has been 

 nancy. written on this aspect of the subject. In 1911 Clifford 



White 1 briefly reviewed the literature, and found it as 

 contradictory as the literature usually is on subjects con- 

 nected with the internal secretions. I think there can be 

 no doubt that excess of thyroid secretion, except that 

 seen in connexion with an advanced stage of Graves' 

 disease, does not interfere with fertility. It would be 

 strange if it did, for we know that there is an increase 

 in thyroid activity during the early months of pregnancy, 

 and possibly throughout ; but it is no less a fact that 

 women with marked exophthalmic goitre rarely become 

 pregnant, and if they do the disease is aggravated. In 

 the case of one patient who had suffered with exophthal- 

 mic goitre for some years and had given birth to several 

 children, there had always been haemorrhage after 

 delivery — an occurrence which has not infrequently been 

 noted in these cases. One of my colleagues removed 

 one half of the thyroid gland, with the result that there 

 was marked amelioration in her symptoms. Shortly 

 afterwards, however, she became pregnant again, and 

 this caused her symptoms to become considerably worse 

 than they had been since her operation, so I suggested 

 that she should take large doses of calcium lactate, and 

 should rest as much as possible. Subsequently she 

 went comfortably to full term, and there was no post- 

 partum haemorrhage. The patient was advised not to 

 nurse the child, which was normal, owing to the drain 

 on her lime salts lactation would entail. There was 

 very considerable improvement after parturition, and 

 the patient subsequently remained in good health. 



It is most important that these women should be 

 given large doses of calcium salts if they become pregnant, 



1 White, Clifford, Journ. Obstet. and Gyncecol. Brit. Emp., 1911, 

 vol. xx, p. 126. 



